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The Official CORONAVIRUS oh *&^! thread. Time to start stocking up on food?


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This is another  concern:
 

The Chinese National Health Commission recently changed their definition of a “confirmed case”. Previously it was reported that a confirmed case is a patient who is either symptomatic or asymptomatic who had a positive test result. The change in their guideline which was dated February 7th states that a confirmed case requires symptoms + positive test. Those patients who are currently asymptomatic with a positive result are not deemed as “confirmed”...

 

Slightly concerning for reporting cases.. what about viral shedding?? 
 

Transparency hasn’t been any countries strong suit. 

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51 minutes ago, DarwinStarwin said:

So this is probably the stupidest question to come of the post, but how does a regular ole' family practice PA seeing patients with respiratory concerns, cold/flu-like sx, and recent travel hx (or concerns for possible exposure... tourist town...), test for the Wuhan virus?

It's a send off lol.  Good luck.

The single biggest risk is, " have you recently traveled to China or have you been in contact with anyone who has...?"  If the answer is yes....You should go full Planet of the Apes protocol.........!  😄 

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1 hour ago, DarwinStarwin said:

So this is probably the stupidest question to come of the post, but how does a regular ole' family practice PA seeing patients with respiratory concerns, cold/flu-like sx, and recent travel hx (or concerns for possible exposure... tourist town...), test for the Wuhan virus?

I honestly applaud you for asking this now...before actually seeing a case.

I had a coworker last year who (incorrectly) felt strongly we had a case of measles in the office, ordering labs and so forth...and then allowed the patient to leave!  Yeah, that's not the protocol for possible measles.  I happened to field the call the next day from our local health department official after she was called by the school...yeah...that was fun. 

Worse was that this was around the time Detroit had it's outbreak so everyone was on HIGH alert...

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17 minutes ago, mgriffiths said:

I honestly applaud you for asking this now...before actually seeing a case.

I had a coworker last year who (incorrectly) felt strongly we had a case of measles in the office, ordering labs and so forth...and then allowed the patient to leave!  Yeah, that's not the protocol for possible measles.  I happened to field the call the next day from our local health department official after she was called by the school...yeah...that was fun. 

Worse was that this was around the time Detroit had it's outbreak so everyone was on HIGH alert...

Honestly, I really didn't get a thorough education in my PA program on how and when to interface with the local health department.  I would likely have made the same mistake in my first year or two of practice.

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Are we really still comparing this to the flu?

 

Japan is quarantining people at sea.  Hong Kong has closed the boarder and North Korea who identified their first case of Coronavirus.... executed the patient.  

True story.  

 

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Strangely quiet here.  Let's recap this week:
* It's airborne, not just droplet.
* It's fecal-oral, too.
* Spread before symptoms is now confirmed by consensus.
* It's showing up in force and killing people in places that didn't have recognized outbreaks a day or two ago, like Iran and South Korea.
* In early places to have seen it, (HK, Singapore) it continues to spread in the community despite quarantine and contact tracking efforts.
* R0 is still 2-3, case fatality rate is still 1-2% in places where the medical system is NOT overwhelmed.

 

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Only a matter of time before it hits here in the US in force.  South Korea is now getting blasted with it.  My guess is either California or NY first and it's gonna hit hard.  Our for profit medical system is NOT set up for care of a volume producing illness.  We are set up to maximize profits (limited beds etc).  I think it's going to be a hell of a nightmare in a few months.

My question is...how many people who are uninsured or under insured are going to go bankrupt when hospitals start sending out the bills....

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Interesting article: 

https://www.thelancet.com/pb-assets/Lancet/pdfs/S2213260020300795.pdf

A retrospective study but pretty sure anything we learn about this virus will be in the retrospective format. Small sample size but fairly shocking for those at increased risk. 
Did anyone listen to the tele-briefing from the CDC yesterday?

https://www.cdc.gov/media/releases/2020/a0221-cdc-telebriefing-covid-19.html

 

They aren’t really instilling confidence that this can be contained let alone have a reliable test for this. The comment about possibly having to close schools and business sounds pretty ominous. WHO seem to be shuffling their feet and don’t appear to have any urgency to get to where the initial outbreak occurred to get answers, though I can’t 100% blame them. 
 

Could get interesting here soon. Waiting for the day we have to don full PPE to work. Stay safe out there! 

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2.      We also recommend that people might want to slowly (so no one will accuse them of panic-buying) start to stock up on enough non-perishable food to last their households through several weeks of social distancing at home during an intense wave of transmission in their community.  This too seems to get through emotionally, as well as being useful logistically.

 

 

The title of my thread is starting to look a lot more plausible.....

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So South Korea is testing the hell out of everyone, and they're finding hundreds of cases--763, current count, with 7 dead.  Canada found a case in an immigrant from Iran, because they tested.  With Iran and Italy going from "no cases" to "deaths" essentially instantaneously, that likely means the virus has been circulating there for 2-3 weeks.

In reporting areas with reasonably good to excellent public health reporting, democracy, and/or transparency and press freedom, we're seeing a ratio of deaths:cases out of line with what PRC has reported.  Hong Kong, 2:74. Singapore, 0:89.  South Korea 7:763. Japan, 1:147, not counting cruise ship fatalities.  Add that all up, and we're seeing about a 1% instantaneous (current) case fatality rate, as people are still infected and hospitalized.  The Diamond Princess victims, at 3:691 are a special case, as it would seem that they would have matured towards a 1% instantaneous case fatality rate by now... which ominously suggests that many of those infections might have been relatively to quite recent.

In China, we're seeing 2,500:77,000, which probably means there are 150,000 or more un-diagnosed cases out there, assuming they're accurately reporting deaths (hah).  In Iran, we've got 8:43, which suggests that maybe 5% of the potential cases have been identified.

After all this, CDC is still tightly controlling testing, centralized in Atlanta and not letting state public health departments in on the action. Nothing against South Korea, but we should be able to test far more, far more efficiently than they are, right?  We're not testing people based on symptoms without having a) been to Wuhan, or b) documented contact with a lab-confirmed case, as I understand it, ostensibly to prevent overtesting of seasonal flu.

This smells very much like someone is trying to buy time before panicking the U.S. public.  Which, given the asshattery over repatriating our own citizen victims to Spokane, Costa Mesa, and Alabama, may just be a very good idea.

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17 minutes ago, rev ronin said:

After all this, CDC is still tightly controlling testing, centralized in Atlanta and not letting state public health departments in on the action. Nothing against South Korea, but we should be able to test far more, far more efficiently than they are, right?  We're not testing people based on symptoms without having a) been to Wuhan, or b) documented contact with a lab-confirmed case, as I understand it, ostensibly to prevent overtesting of seasonal flu.

This smells very much like someone is trying to buy time before panicking the U.S. public.  Which, given the asshattery over repatriating our own citizen victims to Spokane, Costa Mesa, and Alabama, may just be a very good idea.

It would be nice to at least have testing available in a timely fashion. Especially if you are considering it in a ddx. Last week we had a slew of patients (Children and adults) in our clinic that presented with respiratory symptoms with fever (>101F) with no travel history, so no criteria met. All had negative influenza, CXR, Rapid strep with culture, negative UA. Could have just been a gnarly virus but I can say that this COVID-19 did enter my mind.  
 

Taking my clinician hat off:  Gut feeling is that it’s going to hit the fan by the end of the week. Just in time for my work week to start. 😳

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I agree that DPH/CDC is doing very limited testing. In order to tests we have to call DPH who makes the call whether or not we can test. They collect the samples and send them to CDC in Atlanta.

I work at a outpatient clinic that sees many Chinese immigrant patients. We have seen quite a number who returned from China recently. We had a few suspicious cases. Some we are unable to test due to the strict criteria that DPH implements. The few that we have tested has fortunately they turned out negative so far. However, I want to share one case from about 3-4 weeks ago that concerned many of us.

A middle aged male who returned from China (outside Hubei) a week prior. He went to clinic for fever and cough. Flu test was negative. Provider 1 also didn't take travel history. He treated for viral cold.

Patient return to clinic few days later for persistent fever and cough. Provider 2 this time took a travel history and masked up properly. Provider 2 was suspicious and called DPH who said to not test since patient doesn't fit criteria. Provider 2, erring on side of caution, orders CXR. Patient goes to radiology dept the next day. (Btw patient took public transit to another clinic and went to radiology without a mask!).

CXR is positive for infiltrate. Provider 2 prescribes abx and calls DPH again who still decides not to test patient since patient is still outside criteria.

A few days later after CXR, patient develops shortness of breath and ends up needing hospitalization. DPH finally tests him. Fortunately negative! However, it was very concerning to us providers. Had it been positive, imagine all the people he may have exposed during the multiple visits to our clinic sites from sitting in waiting room to radiology to public transit. So the criteria is very strict and I also would not be surprised if the virus has already set foot here and spreading quietly through carriers from outside Hubei.





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7 hours ago, pavlovacloud said:


 

WOW!!!

 

Not going to lie...wife and I went to the store yesterday and bought a large amount of non-perishable food, water, etc.  If the SHTF truly, we would have enough food for a decent time...but water is the part that is usually underestimated.  We probably have enough for 5-7 days using the FEMA calculation of 1 gallon per person per day (hard to calculate for 1.5yo, pregnant wife due in May, and dogs).  Even if the worst doesn't happen, should have at least the majority of what we bought on hand anyway...

I covered our UC over this past weekend...MANY patients with negative flu/strep that had consistent symptoms but didn't meet testing criteria...then I find out that there are 325 under observation in my state (MI) and being asked to self-quarantine (because that works...🤔)!!!  We're relatively rural, sort of...but this seems to be spiraling pretty rapidly.

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